CIO wrangles data for first step to ACO

April 10, 2014 in Medical Technology

?Like most CIOs of three-hospital health systems, Karen Bowling has plenty keeping her busy these days. Now there’s more to do. With the mission of meeting a slew of federal mandates pretty much well in hand, it’s time to help steer toward a future of accountable care.

[See also: ACOs and meaningful use to go hand in hand]

As chief information officer of New England-wide Covenant Health Systems — which has hospitals in Lewiston and Bangor, Maine, and Nashua, N.H., with a couple-dozen long-term care facilities spread throughout the region — Bowling and her 60-person IT team have a full plate managing meaningful use attestation. So far that’s going according to plan, with hospitals “marching along to Stage 2,” said Bowling. 


And when she spoke with Healthcare IT News recently — a few weeks before Congress’ sneak-attack delay threw a monkey wrench into the planning process — ICD-10 conversion had been chugging right along, too. Acknowledging a fact that would soon ring even more truthfully, Bowling said Covenant had planning committees in place, was “in good shape” with software and had started training its providers: “But it’s kind of a Catch-22 because you want to teach them as much as you can early — but not too early, because they’ll forget it by the time they need it.” 


[See also: CIO: No longer just 'the IT guy']

But if ICD-10 is in limbo, payment reform sure isn’t. And now Covenant is eyeing the transition to an ACO model, taking a broader view of the health of its population of mostly-elderly patients. 


To do that, the self-insured health system is dipping its toes in the water by first setting up the infrastructure of an “employee ACO” for its 7,000 staffers across New England.


With help from analytics platform developed by Emeryville, Calif.-based MedeAnalytics, Covenant is working to aggregate and normalize claims and health record data, along with other information related to cost and patient satisfaction.


The hope is to sniff out gaps in care and stratify patient populations by risk — bettering the health of its employees while also laying the groundwork and setting up best practices for similar efforts on a broader scale.


“We are PPO, not HMO, so we struggle to capture data,” Bowling explained. “Patients don’t have to have primary care physicians from our organization; they can go anywhere.”


So with this employee based pilot, “we started small, capturing data from our third-party administrators,” she said. “We hope to have our HR areas study the data from a benefits perspective: Where is it costing us money and what can we do?” 


Then, of course, there’s “the care management side — all of our physician practices — and getting them information about the patients, so they can take a look at cases that may be escalating, so it won’t become higher-cost,” she said.


The initial demo of the project kicked off this past summer. “On our team we had HR folks, we had people who are working with ACOs and sending data there, people who are knowledgeable about sending data to health information exchanges, finance people who were part of our team,” said Bowling.  


With the initiative under way in earnest since January, there are weekly meetings, related to everything from rule-based security to patient privacy protections and more, she said. On her list of priorities, “it’s one of the top ones,” right up there with meaningful use.


“From an organizational perspective, the CEO and project developers said this was going to be important,” said Bowling. “It is a focus, and they’re looking to being live.”

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